Surgical stapler buttress assembly with adhesion to wet end effector

ABSTRACT

A buttress assembly is configured to temporarily adhere to a wet surgical stapler end effector. The buttress assembly includes a buttress body and a humidity tolerant adhesive material. The humidity tolerant adhesive material is applied to at least one side of the buttress body. The humidity tolerant adhesive material is configured to hold the buttress body to an underside of an anvil or a deck of a staple cartridge for at least five minutes in an environment of 100% relative humidity at approximately 37° C.

This application is a continuation of U.S. patent application Ser. No.16/727,348, entitled “Surgical Stapler Buttress Assembly with Adhesionto Wet End Effector,” filed on Dec. 26, 2019 and published as U.S.Patent Publication No. 2020.0187940 on Jun. 18, 2020, issued as U.S.Pat. No. 11,234,699 on Feb. 1, 2022, which is a continuation of U.S.patent application Ser. No. 14/926,057, entitled “Surgical StaplerButtress Assembly with Adhesion to Wet End Effector,” filed on Oct. 29,2015 and issued as U.S. Pat. No. 10,517,592 on Dec. 31, 2019.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through the cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasonic vibration,RF, laser, etc.). Endoscopic surgical instruments may include a shaftbetween the end effector and a handle portion, which is manipulated bythe clinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient. Positioning of anend effector may be further facilitated through inclusion of one or morearticulation joints or features, enabling the end effector to beselectively articulated or otherwise deflected relative to thelongitudinal axis of the shaft.

Examples of endoscopic surgical instruments include surgical staplers.Some such staplers are operable to clamp down on layers of tissue, cutthrough the clamped layers of tissue, and drive staples through thelayers of tissue to substantially seal the severed layers of tissuetogether near the severed ends of the tissue layers. Merely exemplarysurgical staplers are disclosed in U.S. Pat. No. 4,805,823, entitled“Pocket Configuration for Internal Organ Staplers,” issued Feb. 21,1989; U.S. Pat. No. 5,415,334, entitled “Surgical Stapler and StapleCartridge,” issued May 16, 1995; U.S. Pat. No. 5,465,895, entitled“Surgical Stapler Instrument,” issued Nov. 14, 1995; U.S. Pat. No.5,597,107, entitled “Surgical Stapler Instrument,” issued Jan. 28, 1997;U.S. Pat. No. 5,632,432, entitled “Surgical Instrument,” issued May 27,1997; U.S. Pat. No. 5,673,840, entitled “Surgical Instrument,” issuedOct. 7, 1997; U.S. Pat. No. 5,704,534, entitled “Articulation Assemblyfor Surgical Instruments,” issued Jan. 6, 1998; U.S. Pat. No. 5,814,055,entitled “Surgical Clamping Mechanism,” issued Sep. 29, 1998; U.S. Pat.No. 6,978,921, entitled “Surgical Stapling Instrument Incorporating anE-Beam Firing Mechanism,” issued Dec. 27, 2005; U.S. Pat. No. 7,000,818,entitled “Surgical Stapling Instrument Having Separate Distinct Closingand Firing Systems,” issued Feb. 21, 2006; U.S. Pat. No. 7,143,923,entitled “Surgical Stapling Instrument Having a Firing Lockout for anUnclosed Anvil,” issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled“Surgical Stapling Instrument Incorporating a Multi-Stroke FiringMechanism with a Flexible Rack,” issued Dec. 4, 2007; U.S. Pat. No.7,367,485, entitled “Surgical Stapling Instrument Incorporating aMultistroke Firing Mechanism Having a Rotary Transmission,” issued May6, 2008; U.S. Pat. No. 7,380,695, entitled “Surgical Stapling InstrumentHaving a Single Lockout Mechanism for Prevention of Firing,” issued Jun.3, 2008; U.S. Pat. No. 7,380,696, entitled “Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism,”issued Jun. 3, 2008; U.S. Pat. No. 7,404,508, entitled “SurgicalStapling and Cutting Device,” issued Jul. 29, 2008; U.S. Pat. No.7,434,715, entitled “Surgical Stapling Instrument Having MultistrokeFiring with Opening Lockout,” issued Oct. 14, 2008; U.S. Pat. No.7,721,930, entitled “Disposable Cartridge with Adhesive for Use with aStapling Device,” issued May 25, 2010; U.S. Pat. No. 8,408,439, entitled“Surgical Stapling Instrument with An Articulatable End Effector,”issued Apr. 2, 2013; and U.S. Pat. No. 8,453,914, entitled “Motor-DrivenSurgical Cutting Instrument with Electric Actuator Directional ControlAssembly,” issued Jun. 4, 2013. The disclosure of each of theabove-cited U.S. Patents is incorporated by reference herein.

While the surgical staplers referred to above are described as beingused in endoscopic procedures, it should be understood that suchsurgical staplers may also be used in open procedures and/or othernon-endoscopic procedures. By way of example only, a surgical staplermay be inserted through a thoracotomy, and thereby between a patient'sribs, to reach one or more organs in a thoracic surgical procedure thatdoes not use a trocar as a conduit for the stapler. Such procedures mayinclude the use of the stapler to sever and close a vessel leading to alung. For instance, the vessels leading to an organ may be severed andclosed by a stapler before removal of the organ from the thoraciccavity. Of course, surgical staplers may be used in various othersettings and procedures.

Examples of surgical staplers that may be particularly suited for usethrough a thoracotomy are disclosed in U.S. Patent Pub. No.2014/0243801, entitled “Surgical Instrument End Effector ArticulationDrive with Pinion and Opposing Racks,” published Aug. 28, 2014; issuedas U.S. Pat. No. 9,186,142 on Nov. 17, 2015; U.S. Patent Pub. No.2014/0239041, entitled “Lockout Feature for Movable Cutting Member ofSurgical Instrument,” published Aug. 28, 2014; issued as U.S. Pat. No.9,717,497 on Aug. 1, 2017; U.S. Patent Pub. No. 2014/0239042, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” published Aug. 28, 2014; issued as U.S. Pat. No. 9,517,065 onDec. 13, 2016; U.S. Patent Pub. No. 2014/0239036, entitled “Jaw ClosureFeature for End Effector of Surgical Instrument,” published Aug. 28,2014, issued as U.S. Pat. No 9,839,421 on Dec. 12, 2017; U.S. PatentPub. No. 2014/0239040, entitled “Surgical Instrument with ArticulationLock having a Detenting Binary Spring,” published Aug. 28, 2014, issuedas U.S. Pat. No. 9,867,615 on Jan. 16, 2018; U.S. Patent Pub. No.2014/0239043, entitled “Distal Tip Features for End Effector of SurgicalInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,622,746on Apr. 18, 2017; U.S. Patent Pub. No. 2014/0239037, entitled “StapleForming Features for Surgical Stapling Instrument,” published Aug. 28,2014, issued as U.S. Pat. No. 10,092,292 on Oct. 9, 2018; U.S. PatentPub. No. 2014/0239038, entitled “Surgical Instrument with Multi-DiameterShaft,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,795,379 onOct. 24, 2017; and U.S. Patent Pub. No. 2014/0239044, entitled“Installation Features for Surgical Instrument End Effector Cartridge,”published Aug. 28, 2014, issued as U.S. Pat. No. 9,808,248 on Nov. 7,2017. The disclosure of each of the above-cited U.S. Patent Publicationsis incorporated by reference herein.

Additional surgical stapling instruments are disclosed in U.S. Pat. No.8,801,735, entitled “Surgical Circular Stapler with Tissue RetentionArrangements,” issued Aug. 12, 2014; U.S. Pat. No. 8,141,762, entitled“Surgical Stapler Comprising a Staple Pocket,” issued Mar. 27, 2012;U.S. Pat. No. 8,371,491, entitled “Surgical End Effector Having ButtressRetention Features,” issued Feb. 12, 2013; U.S. Pub. No. 2014/0263563,entitled “Method and Apparatus for Sealing End-to-End Anastomosis”published Sep. 18, 2014, issued as U.S. Pat. No. 0,597,082 on Mar. 21,2017; U.S. Pub. No. 2014/0246473, entitled “Rotary Powered SurgicalInstruments with Multiple Degrees of Freedom,” published Sep. 4, 2014,issued on U.S. Pat. No. 9,398,911 on Jul. 26, 2016; U.S. Pub. No.2013/0206813, entitled “Linear Stapler,” published Aug. 15, 2013, nowabondoned; U.S. Pub. No. 2008/0169328, entitled “Buttress Material forUse with a Surgical Stapler,” published Jul. 17, 2008, now abandoned;U.S. patent application Ser. No. 14/300,804, entitled “Woven and FibrousMaterials for Reinforcing a Staple Line,” filed Jun. 10, 2014, issued asU.S. Pat. No. 9,848,871 on Dec. 26, 2017; U.S. patent application Ser.No. 14/300,811, entitled “Devices and Methods for Sealing Staples inTissue”, issued on U.S. Pat. No. 9,936,954 on Apr. 10, 2018; and U.S.patent application Ser. No. 14/498,070, entitled “Radically ExpandableStaple Line” filed Sep. 26, 2014, issued as U.S. Pat. No. 10,426,476 onOct. 1, 2019. The disclosure of each of the above-cited U.S. Patents,U.S. Patent Publications, and U.S. Patent Applications is incorporatedby reference herein.

In some instances, it may be desirable to equip a surgical staplinginstrument with a buttress material to reinforce the mechanicalfastening of tissue provided by staples. Such a buttress may prevent theapplied staples from pulling through tissue and may otherwise reduce arisk of tissue tearing at or near the site of applied staples.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a perspective view of an exemplary articulating surgicalstapling instrument;

FIG. 2 depicts a perspective view of an end effector of the instrumentof FIG. 1 , with the end effector in an open configuration;

FIG. 3 depicts an exploded perspective view of the end effector of FIG.2 ;

FIG. 4 depicts a perspective view of an exemplary upper buttress and anexemplary lower buttress, each of which may be applied to the endeffector of FIG. 2 ;

FIG. 5A depicts a cross-sectional end view of a portion of the endeffector of FIG. 2 with a buttress assembly formed by the buttresses ofFIG. 4 applied to the end effector, with tissue positioned between thebuttresses in the end effector, and with the anvil in an open position;

FIG. 5B depicts a cross-sectional end view of the combined end effectorand buttress assembly of FIG. 5A, with tissue positioned between thebuttresses in the end effector, and with the anvil in a closed position;

FIG. 5C depicts a cross-sectional view of a staple and the buttressassembly of FIG. 5A having been secured to the tissue by the endeffector of FIG. 2 ;

FIG. 6 depicts a perspective view of staples and the buttress assemblyof FIG. 5A having been secured to the tissue by the end effector of FIG.2 ;

FIG. 7 depicts a perspective view of an exemplary alternative buttressassembly;

FIG. 8 depicts a cross-sectional side view of another exemplaryalternative buttress assembly; and

FIG. 9 depicts a cross-sectional side view of another exemplaryalternative buttress assembly.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

I. EXEMPLARY SURGICAL STAPLER

FIG. 1 depicts an exemplary surgical stapling and severing instrument(10) that includes a handle assembly (20), a shaft assembly (30), and anend effector (40). End effector (40) and the distal portion of shaftassembly (30) are sized for insertion, in a nonarticulated state asdepicted in FIG. 1 , through a trocar cannula to a surgical site in apatient for performing a surgical procedure. By way of example only,such a trocar may be inserted in a patient's abdomen, between two of thepatient's ribs, or elsewhere. In some settings, instrument (10) is usedwithout a trocar. For instance, end effector (40) and the distal portionof shaft assembly (30) may be inserted directly through a thoracotomy orother type of incision. It should be understood that terms such as“proximal” and “distal” are used herein with reference to a cliniciangripping handle assembly (20) of instrument (10). Thus, end effector(40) is distal with respect to the more proximal handle assembly (20).It will be further appreciated that for convenience and clarity, spatialterms such as “vertical” and “horizontal” are used herein with respectto the drawings. However, surgical instruments are used in manyorientations and positions, and these terms are not intended to belimiting and absolute.

A. Exemplary Handle Assembly and Shaft Assembly

As shown in FIG. 1 , handle assembly (20) of the present examplecomprises pistol grip (22), a closure trigger (24), and a firing trigger(26). Each trigger (24, 26) is selectively pivotable toward and awayfrom pistol grip (22) as will be described in greater detail below.Handle assembly (20) further includes a removable battery pack (28).These components will also be described in greater detail below. Ofcourse, handle assembly (20) may have a variety of other components,features, and operabilities, in addition to or in lieu of any of thosenoted above. Other suitable configurations for handle assembly (20) willbe apparent to those of ordinary skill in the art in view of theteachings herein.

As shown in FIGS. 1-2 , shaft assembly (30) of the present examplecomprises an outer closure tube (32), an articulation section (34), anda closure ring (36), which is further coupled with end effector (40).Closure tube (32) extends along the length of shaft assembly (30).Closure ring (36) is positioned distal to articulation section (34).Closure tube (32) and closure ring (36) are configured to translatelongitudinally relative to handle assembly (20). Longitudinaltranslation of closure tube (32) is communicated to closure ring (36)via articulation section (34). Exemplary features that may be used toprovide longitudinal translation of closure tube (32) and closure ring(36) will be described in greater detail below.

Articulation section (34) is operable to laterally deflect closure ring(36) and end effector (40) laterally away from the longitudinal axis(LA) of shaft assembly (30) at a desired angle (a). In the presentexample, articulation is controlled through an articulation control knob(35) which is located at the proximal end of shaft assembly (30).Closure ring (36) and end effector (40) pivot about an axis that isperpendicular to the longitudinal axis (LA) of shaft assembly (30) inresponse to rotation of knob (35). Articulation section (34) isconfigured to communicate longitudinal translation of closure tube (32)to closure ring (36), regardless of whether articulation section (34) isin a straight configuration or an articulated configuration. By way ofexample only, articulation section (34) and/or articulation control knob(35) may be constructed and operable in accordance with at least some ofthe teachings of U.S. Pub. No. 2014/0243801, entitled “SurgicalInstrument End Effector Articulation Drive with Pinion and OpposingRacks,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,186,142, onNov. 17, 2015, the disclosure of which is incorporated by referenceherein; and/or U.S. patent application Ser. No. 14/314,125, entitled“Articulation Drive Features for Surgical Stapler,” filed Jun. 25, 2014,issued as U.S. Pat. No. 10,292,701 on May 21, 2019, the disclosure ofwhich is incorporated by reference herein; and/or in accordance with thevarious teachings below. Other suitable forms that articulation section(34) and articulation knob (35) may take will be apparent to those ofordinary skill in the art in view of the teachings herein.

As shown in FIG. 1 , shaft assembly (30) of the present example furtherincludes a rotation knob (31). Rotation knob (31) is operable to rotatethe entire shaft assembly (30) and end effector (40) relative to handleassembly (20) about the longitudinal axis (LA) of shaft assembly (30).Of course, shaft assembly (30) may have a variety of other components,features, and operabilities, in addition to or in lieu of any of thosenoted above. By way of example only, at least part of shaft assembly(30) is constructed in accordance with at least some of the teachings ofU.S. Pub. No. 2014/0239038, entitled “Surgical Instrument withMulti-Diameter Shaft,” published Aug. 28, 2014, issued as U.S. Pat. No.9,795,379, on Oct. 24, 2017,the disclosure of which is incorporated byreference herein. Other suitable configurations for shaft assembly (30)will be apparent to those of ordinary skill in the art in view of theteachings herein.

B. Exemplary End Effector

As also shown in FIGS. 1-3 , end effector (40) of the present exampleincludes a lower jaw (50) and a pivotable anvil (60). Anvil (60)includes a pair of integral, outwardly extending pins (66) that aredisposed in corresponding curved slots (54) of lower jaw (50). Anvil(60) is pivotable toward and away from lower jaw (50) between an openposition (shown in FIG. 2 ) and a closed position (shown in FIG. 1 ).Use of the term “pivotable” (and similar terms with “pivot” as a base)should not be read as necessarily requiring pivotal movement about afixed axis. For instance, in the present example, anvil (60) pivotsabout an axis that is defined by pins (66), which slide along curvedslots (54) of lower jaw (50) as anvil (60) moves toward lower jaw (50).In such versions, the pivot axis translates along the path defined byslots (54) while anvil (60) simultaneously pivots about that axis. Inaddition or in the alternative, the pivot axis may slide along slots(54) first, with anvil (60) then pivoting about the pivot axis after thepivot axis has slid a certain distance along the slots (54). It shouldbe understood that such sliding/translating pivotal movement isencompassed within terms such as “pivot,” “pivots,” “pivotal,”“pivotable,” “pivoting,” and the like. Of course, some versions mayprovide pivotal movement of anvil (60) about an axis that remains fixedand does not translate within a slot or channel, etc.

As best seen in FIG. 3 , lower jaw (50) of the present example defines achannel (52) that is configured to receive a staple cartridge (70).Staple cartridge (70) may be inserted into channel (52), end effector(40) may be actuated, and then staple cartridge (70) may be removed andreplaced with another staple cartridge (70). Lower jaw (50) thusreleasably retains staple cartridge (70) in alignment with anvil (60)for actuation of end effector (40). In some versions, lower jaw (50) isconstructed in accordance with at least some of the teachings of U.S.Pub. No. 2014/0239044, entitled “Installation Features for SurgicalInstrument End Effector Cartridge,” published Aug. 28, 2014, issued asU.S. Pat. No. 9,808,248, on Nov. 7, 2017, the disclosure of which isincorporated by reference herein. Other suitable forms that lower jaw(50) may take will be apparent to those of ordinary skill in the art inview of the teachings herein.

As best seen in FIGS. 2-3 , staple cartridge (70) of the present examplecomprises a cartridge body (71) and a tray (76) secured to the undersideof cartridge body (71). The upper side of cartridge body (71) presents adeck (73), against which tissue may be compressed when anvil (60) is ina closed position. Cartridge body (71) further defines a longitudinallyextending channel (72) and a plurality of staple pockets (74). A staple(90) is positioned in each staple pocket (74). A staple driver (75) isalso positioned in each staple pocket (74), underneath a correspondingstaple (90), and above tray (76). As will be described in greater detailbelow, staple drivers (75) are operable to translate upwardly in staplepockets (74) to thereby drive staples (90) upwardly through staplepockets (74) and into engagement with anvil (60). Staple drivers (75)are driven upwardly by a wedge sled (78), which is captured betweencartridge body (71) and tray (76), and which translates longitudinallythrough cartridge body (71).

Wedge sled (78) includes a pair of obliquely angled cam surfaces (79),which are configured to engage staple drivers (75) and thereby drivestaple drivers (75) upwardly as wedge sled (78) translateslongitudinally through cartridge (70). For instance, when wedge sled(78) is in a proximal position, staple drivers (75) are in downwardpositions and staples (90) are located in staple pockets (74). As wedgesled (78) is driven to the distal position by a translating knife member(80), wedge sled (78) drives staple drivers (75) upwardly, therebydriving staples (90) out of staple pockets (74) and into staple formingpockets (64) that are formed in the underside (65) of anvil (60). Thus,staple drivers (75) translate along a vertical dimension as wedge sled(78) translates along a horizontal dimension.

In some versions, staple cartridge (70) is constructed and operable inaccordance with at least some of the teachings of U.S. Pub. No.2014/0239042, entitled “Integrated Tissue Positioning and Jaw AlignmentFeatures for Surgical Stapler,” published Aug. 28, 2014, issued as U.S.Pat. No. 9,517,065 on Dec. 13, 2016, the disclosure of which isincorporated by reference herein. In addition or in the alternative,staple cartridge (70) may be constructed and operable in accordance withat least some of the teachings of U.S. Pub. No. 2014/0239044, entitled“Installation Features for Surgical Instrument End Effector Cartridge,”published Aug. 28, 2014, issued as U.S. Pat. No. 9,808,248, on Nov. 7,2017, the disclosure of which is incorporated by reference herein. Othersuitable forms that staple cartridge (70) may take will be apparent tothose of ordinary skill in the art in view of the teachings herein.

As best seen in FIG. 2 , anvil (60) of the present example comprises alongitudinally extending channel (62) and a plurality of staple formingpockets (64). Channel (62) is configured to align with channel (72) ofstaple cartridge (70) when anvil (60) is in a closed position. Eachstaple forming pocket (64) is positioned to lie over a correspondingstaple pocket (74) of staple cartridge (70) when anvil (60) is in aclosed position. Staple forming pockets (64) are configured to deformthe legs of staples (90) when staples (90) are driven through tissue andinto anvil (60). In particular, staple forming pockets (64) areconfigured to bend the legs of staples (90) to secure the formed staples(90) in the tissue. Anvil (60) may be constructed in accordance with atleast some of the teachings of U.S. Pub. No. 2014/0239042, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,517,065 onDec. 13, 2016; at least some of the teachings of U.S. Pub. No.2014/0239036, entitled “Jaw Closure Feature for End Effector of SurgicalInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 9,839,421on Dec. 12, 2017; and/or at least some of the teachings of U.S. Pub. No.2014/0239037, entitled “Staple Forming Features for Surgical StaplingInstrument,” published Aug. 28, 2014, issued as U.S. Pat. No. 10,092,292on Oct. 9, 2018, the disclosure of which is incorporated by referenceherein. Other suitable forms that anvil (60) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

In the present example, a knife member (80) is configured to translatethrough end effector (40). As best seen in FIG. 3 , knife member (80) issecured to the distal end of a firing beam (82), which extends through aportion of shaft assembly (30). As best seen in FIG. 2 , knife member(80) is positioned in channels (62, 72) of anvil (60) and staplecartridge (70). Knife member (80) includes a distally presented cuttingedge (84) that is configured to sever tissue that is compressed betweenanvil (60) and deck (73) of staple cartridge (70) as knife member (80)translates distally through end effector (40). As noted above, knifemember (80) also drives wedge sled (78) distally as knife member (80)translates distally through end effector (40), thereby driving staples(90) through tissue and against anvil (60) into formation.

C. Exemplary Actuation of End Effector

In the present example, anvil (60) is driven toward lower jaw (50) byadvancing closure ring (36) distally relative to end effector (40).Closure ring (36) cooperates with anvil (60) through a camming action todrive anvil (60) toward lower jaw (50) in response to distal translationof closure ring (36) relative to end effector (40). Similarly, closurering (36) may cooperate with anvil (60) to open anvil (60) away fromlower jaw (50) in response to proximal translation of closure ring (36)relative to end effector (40). By way of example only, closure ring (36)and anvil (60) may interact in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239036, entitled “Jaw Closure Featurefor End Effector of Surgical Instrument,” published Aug. 28, 2014,issued as U.S. Pat. No. 9,839,421 on Dec. 12, 2017, the disclosure ofwhich is incorporated by reference herein; and/or in accordance with atleast some of the teachings of U.S. patent application Ser. No.14/314,108, entitled “Jaw Opening Feature for Surgical Stapler,” filedon Jun. 25, 2014, issued as U.S. Pat. No. 10,335,147 on Jul. 2, 2019,the disclosure of which is incorporated by reference herein.

As noted above, handle assembly (20) includes a pistol grip (22) and aclosure trigger (24). As also noted above, anvil (60) is closed towardlower jaw (50) in response to distal advancement of closure ring (36).In the present example, closure trigger (24) is pivotable toward pistolgrip (22) to drive closure tube (32) and closure ring (36) distally.Various suitable components that may be used to convert pivotal movementof closure trigger (24) toward pistol grip (22) into distal translationof closure tube (32) and closure ring (36) relative to handle assembly(20) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

Also in the present example, instrument (10) provides motorized controlof firing beam (82). In particular, instrument (10) includes motorizedcomponents that are configured to drive firing beam (82) distally inresponse to pivoting of firing trigger (26) toward pistol grip (22). Insome versions, a motor (not shown) is contained in pistol grip (22) andreceives power from battery pack (28). This motor is coupled with atransmission assembly (not shown) that converts rotary motion of a driveshaft of the motor into linear translation of firing beam (82). By wayof example only, the features that are operable to provide motorizedactuation of firing beam (82) may be configured and operable inaccordance with at least some of the teachings of U.S. Pat. No.8,210,411, entitled “Motor-Driven Surgical Instrument,” issued Jul. 3,2012, the disclosure of which is incorporated by reference herein.; U.S.Pat. No. 8,453,914, entitled “Motor-Driven Surgical Cutting Instrumentwith Electric Actuator Directional Control Assembly,” issued Jun. 4,2013, the disclosure of which is incorporated by reference herein;and/or U.S. patent application Ser. No. 14/226,142, entitled “SurgicalInstrument Comprising a Sensor System,” filed Mar. 26, 2014, issued asU.S. Pat. No. 9,913,642 on Mar. 13, 2018, the disclosure of which isincorporated by reference herein.

It should also be understood that any other components or features ofinstrument (10) may be configured and operable in accordance with any ofthe various references cited herein. Additional exemplary modificationsthat may be provided for instrument (10) will be described in greaterdetail below. Various suitable ways in which the below teachings may beincorporated into instrument (10) will be apparent to those of ordinaryskill in the art. Similarly, various suitable ways in which the belowteachings may be combined with various teachings of the references citedherein will be apparent to those of ordinary skill in the art. It shouldtherefore be understood that the teachings below may be readilyincorporated into the various instruments taught in the variousreferences that are cited herein. It should also be understood that thebelow teachings are not limited to instrument (10) or devices taught inthe references cited herein. The below teachings may be readily appliedto various other kinds of instruments, including instruments that wouldnot be classified as surgical staplers. Various other suitable devicesand settings in which the below teachings may be applied will beapparent to those of ordinary skill in the art in view of the teachingsherein.

II. EXEMPLARY BUTTRESS ASSEMBLY FOR SURGICAL STAPLER

In some instances, it may be desirable to equip end effector (40) with abuttress material to reinforce the mechanical fastening of tissueprovided by staples (90). Such a buttress may prevent the appliedstaples (90) from pulling through the tissue and may otherwise reduce arisk of tissue tearing at or near the site of applied staples (90). Inaddition to or as an alternative to providing structural support andintegrity to a line of staples (90), a buttress may provide variousother kinds of effects such as spacing or gap-filling, administration oftherapeutic agents, and/or other effects. In some instances, a buttressmay be provided on deck (73) of staple cartridge (70). In some otherinstances, a buttress may be provided on the surface of anvil (60) thatfaces staple cartridge (70). It should also be understood that a firstbuttress may be provided on deck (73) of staple cartridge (70) while asecond buttress is provided on anvil (60) of the same end effector (40).Various examples of forms that a buttress may take will be described ingreater detail below. Various ways in which a buttress may be secured toa staple cartridge (70) or an anvil (60) will also be described ingreater detail below.

A. Exemplary Composition of Buttress Assembly for Surgical Stapler

FIG. 4 shows an exemplary pair of buttress assemblies (100, 110) with abasic composition. Buttress assembly (100) of this example comprises abuttress body (102) and an upper adhesive layer (104). Similarly,buttress assembly (110) comprises a buttress body (112) and a loweradhesive layer (114). In the present example, each buttress body (102,112) comprises a strong yet flexible material configured to structurallysupport a line of staples (90). By way of example only, each buttressbody (102, 112) may comprise a mesh of polyglactin 910 material byEthicon, Inc. of Somerville, N.J. Alternatively, any other suitablematerials or combinations of materials may be used in addition to or asan alternative to polyglactin 910 material to form each buttress body(102, 112). Each buttress body (102, 112) may take any other suitableform and may be constructed of any other suitable material(s). By way offurther example only, each buttress body (102, 112) may comprise one ormore of the following: NEOVEIL absorbable PGA felt by Gunze Limited, ofKyoto, Japan; SEAMGUARD polyglycolic acid:trimethylene carbonate(PGA:TMC) reinforcement material by W.L. Gore & Associates, Inc., ofFlagstaff, Ariz.; PERI-STRIPS DRY with VERITAS Collagen Matrix (PSDV)reinforcement material, by Baxter Healthcare Corporation of Deerfield,Ill.; BIODESIGN biologic graft material by Cook Medical, Bloomington,Ind.; and/or SURGICEL NU-KNIT hemostat material by Ethicon, Inc. ofSomerville, N.J. Still other suitable materials that may be used to formeach buttress body (102, 112) will be apparent to those of ordinaryskill in the art in view of the teachings herein.

In addition or in the alternative, each buttress body (102, 112) maycomprise a material including, for example, a hemostatic agent such asfibrin to assist in coagulating blood and reduce bleeding at the severedand/or stapled surgical site along tissue (90). As another merelyillustrative example, each buttress body (102, 112) may comprise otheradjuncts or hemostatic agents such as thrombin may be used such thateach buttress body (102, 112) may assist to coagulate blood and reducethe amount of bleeding at the surgical site. Other adjuncts or reagentsthat may be incorporated into each buttress body (102, 112) may furtherinclude but are not limited to medical fluid or matrix components.Merely illustrative examples of materials that may be used to form eachbuttress body (102, 112), as well as materials that may be otherwiseincorporated into each buttress body (102, 112), are disclosed in U.S.patent application Ser. No. 14/667,842, entitled “Method of Applying aButtress to a Surgical Stapler,” filed Mar. 25, 2015, issued as U.S.Pat. No. 10,349,939, on Jul. 16, 2019, the disclosure of which isincorporated by reference herein. Alternatively, any other suitablematerials may be used.

By way of further example only, each buttress body (102, 112) may beconstructed in accordance with at least some of the teachings of U.S.Patent Pub. No. 2012/0241493, entitled “Tissue Thickness CompensatorComprising Controlled Release and Expansion,” published Sep. 27, 2012,issued as U.S. Pat. No. 10,123,798 on Nov. 13, 2018, the disclosure ofwhich is incorporated by reference herein; U.S. Patent Pub. No.2013/0068816, entitled “Surgical Instrument and Buttress Material,”published Mar. 21, 2013, now abandoned, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0062391,entitled “Surgical Instrument with Fluid Fillable Buttress,” publishedMar. 14, 2013, issued as U.S. Pat. No. 9,999,408 on Jun. 19, 2018, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0068820, entitled “Fibrin Pad Matrix with Suspended HeatActivated Beads of Adhesive,” published Mar. 21, 2013, issued as U.S.Pat. No. 8,814025, on Aug. 26, 2014, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0082086,entitled “Attachment of Surgical Staple Buttress to Cartridge,”published Apr. 4, 2013, issued as U.S. Pat. No. 8,899,464 on Dec. 2,2014, the disclosure of which is incorporated by reference herein; U.S.Patent Pub. No. 2013/0037596, entitled “Device for Applying Adjunct inEndoscopic Procedure,” published Feb. 14, 2013, issued as U.S. Pat. No.9,492,170, on Nov. 15, 2016, the disclosure of which is incorporated byreference herein; U.S. Patent Pub. No. 2013/0062393, entitled “ResistiveHeated Surgical Staple Cartridge with Phase Change Sealant,” publishedMar. 14, 2013, issued as U.S. Pat. No. 8,998,060 on Apr. 7, 2015, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0075446, entitled “Surgical Staple Assembly withHemostatic Feature,” published Mar. 28, 2013, issued as U.S. Pat. No.9,393,018 on Jul. 19, 2016, the disclosure of which is incorporated byreference herein; U.S. Patent Pub. No. 2013/0062394, entitled “SurgicalStaple Cartridge with Self-Dispensing Staple Buttress,” published Mar.14, 2013, issued as U.S. Pat. No. 9,101,359 on Aug. 11, 2015, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0075445, entitled “Anvil Cartridge for Surgical FasteningDevice,” published Mar. 28, 2013, issued as U.S. Pat. No. 9,198,644 onDec. 1, 2015, the disclosure of which is incorporated by referenceherein; U.S. Patent Pub. No. 2013/0075447, entitled “Adjunct Therapy forApplying Hemostatic Agent,” published Mar. 28, 2013, now abandoned, thedisclosure of which is incorporated by reference herein; U.S. PatentPub. No. 2013/0256367, entitled “Tissue Thickness Compensator Comprisinga Plurality of Medicaments,” published Oct. 3, 2013, issued as U.S. Pat.No. 9,211,120 on Dec. 15, 2015, the disclosure of which is incorporatedby reference herein; U.S. patent application Ser. No. 14/300,954,entitled “Adjunct Materials and Methods of Using Same in SurgicalMethods for Tissue Sealing,” filed Jun. 10, 2014, issued as U.S. Pat.No. 10,172,611 on Jan. 8, 2019, the disclosure of which is incorporatedby reference herein; U.S. patent application Ser. No. 14/827,856,entitled “Implantable Layers for a Surgical Instrument,” filed Aug. 17,2015, issued as U.S. Pat. No. 10,835,249 on Nov. 17, 2020, thedisclosure of which is incorporated by reference herein; U.S. patentapplication Ser. No. 14/840,613, entitled “Drug Eluting Adjuncts andMethods of Using Drug Eluting Adjuncts,” filed Aug. 31, 2015, issued asU.S. Pat. No. 10,569,071, on Feb. 25, 2020, the disclosure of which isincorporated by reference herein; U.S. patent application Ser. No.14/871,071, entitled “Compressible Adjunct with Crossing Spacer Fibers,”filed Sep. 30, 2015, issued as U.S. Pat. No. 10,433,846, on Oct. 8,2019, the disclosure of which is incorporated by reference herein;and/or U.S. patent application Ser. No. 14/871,131, entitled “Method forApplying an Implantable Layer to a Fastener Cartridge,” filed Sep. 30,2015, published as U.S. Pub. No. 2017/0086842 on Mar. 30, 2017, thedisclosure of which is incorporated by reference herein.

In the present example, adhesive layer (104) is provided on buttressbody (102) in order to adhere buttress body (102) to underside (65) ofanvil (60). Similarly, adhesive layer (114) is provided on buttress body(112) in order to adhere buttress body (112) to deck (73) of staplecartridge (70). Adherence of the buttress body (102) to underside (65)of anvil (60) or to deck (73) of staple cartridge (70) can occur througha variety of mechanisms including but not limited to a pressuresensitive adhesive. In some versions, each adhesive layer (104, 114)comprise a pressure sensitive adhesive material. Examples of varioussuitable materials that may be used to form adhesive layers (104, 114)are disclosed in U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, issued as U.S. Pat. No. 10,349,939, on Jul. 16, 2019, thedisclosure of which is incorporated by reference herein. Alternatively,any other suitable materials may be used. It should be understood thatthe term “adhesive,” as used herein, may include (but is not limited to)tacky materials and also materials that are pliable or wax-like andadhere to a complex geometry via deformation and conformance. Somesuitable adhesives may provide such pliability to adhere to a complexgeometry via deformation and conformance without necessarily providing ahigh initial tack. In some instances, adhesives with lower tackiness maybe removed more cleanly from surfaces. Various suitable materials thatmay be used to form adhesive layers (104, 114) will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

B. Exemplary Materials and Techniques for Providing Adhesion of Buttressto Surgical Stapler

As noted above, a buttress assembly (100) may include a layer (104, 114)of adhesive material (or other form of adhesive material) that adheresbuttress body (102, 112) to either underside (65) of anvil (60) or deck(73) of staple cartridge (70). Such an adhesive material may provideproper positioning of buttress body (102, 112) before and duringactuation of end effector (40); then allow buttress body (102, 112) toseparate from end effector (40) after end effector (40) has beenactuated, without causing damage to buttress body (102, 112) that issubstantial enough to compromise the proper subsequent functioning ofbuttress body (102, 112).

FIGS. 5A-5C show a sequence where an end effector (40) that has beenloaded with buttress assemblies (100, 110) is actuated to drive staples(90) through two apposed layers of tissue (T₁, T₂), with buttressassemblies (100, 110) being secured to the same layers of tissue (T₁,T₂) by staples (90). In particular, FIG. 5A shows layers of tissue (T₁,T₂) positioned between anvil (60) and staple cartridge (70), with anvil(60) in the open position. Buttress assembly (100) is adhered to theunderside (65) of anvil (60) via adhesive layer (104); while buttressassembly (110) is adhered to deck (73) of staple cartridge (70) viaadhesive layer (114). Layers of tissue (T₁, T₂) are thus interposedbetween buttress assemblies (100, 110). Next, trigger (24) is pivotedtoward pistol grip (22) to drive closure tube (32) and closure ring (36)distally. This drives anvil (60) to the closed position as shown in FIG.5B. At this stage, layers of tissue (T₁, T₂) are compressed betweenanvil (60) and staple cartridge (70), with buttress assemblies (100,110) engaging opposite surfaces of tissue layers (T₁, T₂). End effector(40) is then actuated as described above, driving staple (90) throughbuttress assemblies (100, 110) and tissue (90). As shown in FIG. 5C,crown (92) of driven staple (90) captures and retains buttress assembly(110) against layer of tissue (T₂). Deformed legs (94) of staple (90)capture and retain buttress assembly (100) against layer of tissue (T₁).

It should be understood that a series of staples (90) will similarlycapture and retain buttress assemblies (100, 110) against layers oftissue (T₁, T₂), thereby securing buttress assemblies (100, 110) totissue (T₁, T₂) as shown in FIG. 6 . As end effector (40) is pulled awayfrom tissue (90) after deploying staples (90) and buttress assemblies(100, 110), buttress assemblies (100, 110) disengage end effector (40),such that buttress assemblies (100, 110) remain secured to tissue (T₁,T₂) with staples (90). Buttress tissue (T₁, T₂) thus provide structuralreinforcement to the lines of staples (90). As can also be seen in FIG.6 , knife member (80) also cuts through a centerline of buttress tissueassemblies (100, 110), separating each buttress assemblies (100, 110)into a corresponding pair of sections, such that each section remainssecured to a respective severed region of tissue (T₁, T₂).

In the foregoing example, buttress assembly (100) is sized to spanacross the full width of underside (65), such that buttress assembly(100) spans across channel (62). Thus, knife member (80) cuts throughbuttress assembly (100) during actuation of end effector (40) asdescribed above. In some other examples, such as those described below,buttress assembly (100) is provided in two separate, laterally spacedapart portions, with one portion being disposed on underside (65) on oneside of channel (62) and another portion being disposed on underside(65) on the other side of channel (62). In such versions, buttressassembly (100) does not span across channel (62), such that knife member(80) does not cut through buttress assembly (100) during actuation ofend effector (40).

Likewise, buttress assembly (110) may be sized to span across the fullwidth of deck (73), such that buttress assembly (110) spans acrosschannel (72), and such that knife member (80) cuts through buttressassembly (110) during actuation of end effector (40) as described above.Alternatively, buttress assembly (110) may be provided in two separate,laterally spaced apart portions, with one portion being disposed on deck(73) on one side of channel (72) and another portion being disposed ondeck (73) on the other side of channel (72), such that buttress assembly(110) does not span across channel (72), and such that knife member (80)does not cut through buttress assembly (110) during actuation of endeffector (40).

III. TECHNIQUES FOR PROVIDING AND/OR IMPROVING ADHESION OF BUTTRESS TOWET END EFFECTOR

One of ordinary skill in the art will recognize that, during some usesof instrument (10), the operator may need to actuate end effector (40)several times within a patient. Each actuation may require the operatorto remove end effector (40) from the patient, reload a new staplecartridge (70) into lower jaw (50), apply new buttress assemblies (100,110) to anvil (60) and staple cartridge (70), and then insert thereloaded end effector (40) into the patient. Each time end effector (40)is removed from the patient, anvil (60) may be substantially wet withbodily fluids from the patient and/or other fluids in the surgicalfield. Even when a new cartridge (70) is installed in lower jaw (50),the new cartridge (70) may also receive fluids from other portions ofend effector (40) that were already wet. The presence of fluids onunderside (65) of anvil (60) and/or on deck (73) of staple cartridge(70) may make it difficult to adhere buttress assemblies (100, 110) toanvil (60) and staple cartridge (70). The following examples relate tovarious compositions and configurations that may be used to promoteproper adhesion of buttress assemblies (100, 110) to anvil (60) andstaple cartridge (70) when buttress assemblies (100, 110) to anvil (60)and staple cartridge (70) are wet with one or more fluids.

A. Adhesion of Buttress to Wet End Effector Using Humidity TolerantAdhesive Materials

In some surgical applications, it may be desirable to provide a buttressbody (102, 112) with one or more humidity tolerant adhesive materialsthat will at least temporarily adhere to a wet end effector (40),particularly when it is being used intraoperatively. In some instances,humidity tolerant adhesive materials may provide for temporaryattachment of a buttress body (102, 112) to the wet deck (73) of staplecartridge (70) or the wet underside (65) of anvil (60). A humiditytolerant adhesive material is defined herein as an adhesive materialthat holds a buttress body (102, 112) in place on an anvil (60) orstaple cartridge (70) for at least five minutes in an environment of100% relative humidity (e.g., in a patient's body, at a normal bodytemperature of approximately 37° C.), preferably after the buttress body(102, 112) has been exposed to a relative humidity of from about 20% toabout 60% for up to one hour at room temperature (e.g., betweenapproximately 20° C. and approximately 22° C.). In some instances, ahumidity tolerant adhesive material may hold a buttress body (102, 112)in place on an anvil (60) or staple cartridge (70) for at least tenminutes in an environment of 100% relative humidity (e.g., in apatient's body, at a normal body temperature of approximately 37° C.),preferably after the buttress body (102, 112) has been exposed to arelative humidity of from about 20% to about 60% for up to one hour atroom temperature (e.g., between approximately 20° C. and approximately22° C.). A pressure sensitive humidity tolerant adhesive material isdefined herein as a humidity tolerant adhesive material that can betransferred from a delivery device onto an anvil (60) or staplecartridge (70) by the pressure respectively exerted by the anvil (60) orstaple cartridge (70).

As noted above, FIG. 4 shows buttress assemblies (100, 110) that eachcomprises a buttress body (102, 112) and an adhesive layer (104, 114).Adhesive layers (104, 114) respectively provide for temporary attachmentof the buttress bodies (102, 112) to underside (65) of anvil (60) anddeck (73) of staple cartridge (70). It should be understood that thehumidity tolerant adhesive material need not necessarily constitute aseparate adhesive layer (104, 114) that is discretely identifiable asbeing different from a layer defined by buttress body (102, 112).Examples of humidity tolerant adhesive materials that may be otherwiseintegrated onto or into a buttress body (102, 112) are described infurther detail below.

In some instances, the humidity tolerant adhesive materials (e.g., oneor more of layers (104, 114)) for a buttress body (102, 112), comprisepolymers that are either bioabsorbable or of a molecular weight that issufficiently low so as to be cleared from the patient's body (e.g., lessthan approximately 30,000 KDa). Various physiomechanical properties ofpolymers may be modified in order to provide different adhesiveproperties. Such variable characteristics include but are not limited tothe following: copolymer composition; copolymer architecture (e.g.,random vs. block configurations, polymer branching, etc.); glasstransition temperature (Tg); molecular weight; crystallinity; sequencedistribution; copolymer chain composition; melting temperature (Tm);solubility or dissolution rate; rheological properties; surface tension;and combinations thereof. Several exemplary combinations of thesevariables will be provided below, though it should be understood thatthese examples are merely illustrative.

In addition or in the alternative to the aforementioned modifications tothe physiomechanical properties of polymers, some exemplary humiditytolerant adhesive materials may comprise polymers that are combined withsorbents. Useful sorbents may be selected from the group consisting of:polysaccharides such as cellulose; cellulose derivatives, e.g., sodiumcarboxymethylcellulose (Na-CMC); starch; starch derivates; natural gums,e.g., agar and alginates; chitosan; pectin; gelatin; and combinationsthereof. In some examples, a hydrocolloid of one or more sorbents may bemixed with the polymers. In some examples, the humidity tolerantadhesive material comprises a blend of sorbent and polymer in a ratio ina range of 70:30 sorbent to polymer, more particularly in a range of50:50 sorbent to polymer, more preferably in a range of 10:90 sorbent topolymer. Generally it is theorized, but in no way limits the scope ofthis invention, that sorbents may act to absorb moisture away from thesurface interface between the humidity tolerant adhesive material andthe surface to which it is adhered (e.g., a wet end effector (40)), andto maintain the adherence of the buttress body (102, 112) to saidsurface until such time as the buttress body (102, 112) is deployed orreleased from end effector (40) (see, for example, FIG. 5C).

One of the aforementioned physiomechanical properties of polymers isglass transition temperature (Tg). Glass transition temperature is thetemperature at which the mechanical properties of a copolymer changedramatically from a flowable adhesive to a brittle plastic. It may thusbe of importance that the glass transition temperature (Tg) issufficiently below the operating temperature of the humidity tolerantadhesive material in order to allow for sufficient polymer chainmobility. The melting temperature (Tm) of a polymer may be referred toas the “first-order transition,” which is where the polymer changesstate from solid to liquid. Crystalline polymers have a true meltingpoint, which is the temperature at which the crystallites melt and thetotal mass of plastic becomes liquid. Amorphous polymers do not have atrue melting point, but they do have a first-order transition whereintheir mechanical behavior transitions from a rubbery nature to viscousrubbery flow. Suitable polymers for use in humidity tolerant adhesivematerials may be semi-crystalline, i.e., they may have both amorphousand crystalline segments. Suitable polymers may have a melting pointthat is sufficiently above the operating temperature of the humiditytolerant adhesive material to maintain cohesive strength and to providedimensional stability of the applied humidity tolerant adhesivematerial.

The molecular weight of non-bioabsorbable polymers should be high enoughto provide mechanical strength to the resulting adhesive material inorder to avoid cohesive failure, yet low enough that they can be clearedby the patient's body. In the case of biodegradable polymers, an upperlimit on molecular weight may not be required to provide polymerbreakdown products are small enough to be cleared by the patient's body.

The solubility or dissolution rate of polymers in the aqueousenvironments that may be encountered during surgery depend upon a numberof polymer characteristics including, but not limited to: polymercomposition; polymer architecture; degree of cross-linking; blocklength; crystallinity; molecular weight; branching; and combinationsthereof. In illustrative examples described below, certain polymers andco-polymers are chosen and combined with these characteristics in mindin order to decrease the dissolution rate of the resulting humiditytolerant adhesive materials that are of use for adhering a buttress body(102, 112) to a wet end effector (40) during surgery, and maintainingthe adherence of the buttress body to the wet end effector (40) untilsuch time as the buttress body (102, 112) is deployed or released fromend effector (40) (see, for example, FIG. 5C).

The surface tension and rheology of polymers present in a humiditytolerant adhesive material may also impact its adhesive properties. Forexample, if there is a sufficiently large mismatch between the surfacetension of the polymers and the surfaces to which it will adhere,adhesion between the two may be energetically unfavorable. Similarly,the rheological properties of the polymer such as bulk modulus may besuch that the humidity tolerant adhesive material can flow to conform tothe surface topography of the end effector (40), while at the same timeproviding sufficient integrity to maintain cohesive strength and resistshearing and peeling of the buttress body (102, 112) from the endeffector (40).

1. Exemplary Humidity Tolerant Adhesive Materials Comprising PoloxamerBlends

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) may comprise ablend of “plastic fats”, more particularly, poloxamers. In illustrativeexamples, the blend of poloxamers may comprise a blend of poloxamersselected from the group consisting of: poloxamer 188, for exampleKolliphor® P188 from BASF (Florham Park, N.J.); Synperonic® PE/P84 fromCroda Inc. (Edison, N.J.); poloxamer 124, for example Pluronic® L44 fromBASF (Florham Park, N.J.); poloxamer 407, for example Pluronic® F-127from BASF (Florham Park, N.J.); and combinations thereof. Preferably,the poloxamers are of National Formulary grade. The resultingpoloxamer-based humidity tolerant adhesive materials may be putty-likematerials with a relatively low crystallinity and low glass transitiontemperature (Tg). Generally it is theorized, but in no way limits thescope of this invention, that the presence of polypropylene oxide repeatunits in the backbone of the poloxamers provides for a poloxamer blendhaving a slower dissolution rate, which may desirably provide forhumidity tolerant adhesive materials having a greater humidity (i.e.,wetness) tolerance. In turn, a buttress body (102, 112), to whichpoloxamer-based adhesive materials have been applied, may desirablyremain adhered to a wet end effector (40) of a surgical staplinginstrument (10) during a surgical procedure until such time as buttressbody (102, 112) is deployed (see, for example, FIG. 5C).

In some examples, the humidity tolerant adhesive materials comprise apoloxamer blend of poloxamer 188 and Synperonic® PE/P84 in a molar ratioin the range of from 1:3 to 1:4 of poloxamer 188 to Synperonic® PE/P84.In some other examples, humidity tolerant adhesive materials comprise apoloxamer blend of poloxamer 188 and poloxamer 124 in a molar ratio inthe range of from about 1:1 to about 1:4, more particularly from about1:1.5 to about 1:3, of poloxamer 188 to poloxamer 124. In yet some otherexamples, the poloxamer blend may comprise a blend of poloxamer 407 andpoloxamer 124 in a molar ratio in the range of from about 1:1, to about1:5, more particularly from about 1:1.5 to about 1:3 of poloxamer 407 topoloxamer 124.

In yet some other examples, the poloxamers may be combined withnon-ionic surfactants to modify the hydrophobicity of the resultinghumidity tolerant adhesive material. In some such examples, thepoloxamers may be combined with non-ionic surfactants selected from thegroup consisting of: polysorbates; polyethylene glycol hexadecyl ether,for example Brij 52 from Croda Inc. (Edison, N.J.); sorbitanemonooleate, for example, Span® 80 from Sigma Aldrich (Saint Louis, Mo.);and combinations thereof.

In each of the foregoing exemplary poloxamer blends, it may be importantto control the crystallite size of the poloxamers in order to achievethe desirable adhesive characteristics in the resulting humiditytolerant adhesive material.

2. Exemplary Humidity Tolerant Adhesive Materials ComprisingPolyethylene Glycol or Polyethylene-Polyethylene Glycol Co-polymer

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) comprisepolyethylene glycol (PEG) or polyethylene-polyethylene glycolco-polymers (PE-co-PEG). The resulting humidity tolerant adhesivematerials may be putty-like, malleable and extrudable.

In yet further examples, the pressure sensitive humidity tolerantadhesive materials comprise, or consist essentially of,polyethylene-polyethylene glycol co-polymers (PE-co-PEG) with amolecular weight that is sufficiently low so as to be cleared from thepatient's body (e.g., less than approximately 30,000 KDa).

In yet further examples, the humidity tolerant adhesive materialscomprise a blend of polyethylene-polyethylene glycol copolymers(PE-co-PEG) and poly(caprolactone)-glycolide copolymers (PCL/PGA) in theratio of about 40:60 PCL:PGA, preferably in a ratio of about 50:50PCL:PGA, more preferably in a ratio of about 60:40 PCL:PGA. Such a blendmay have low crystallinity and may even be near amorphous.

In yet further examples, the humidity tolerant adhesive materialscomprise a blend of polyethylene glycol having different molecularweights that is in turn blended with a polymer or co-polymer selectedfrom the group consisting of: poloxamers; poly(caprolactone)-glycolidecopolymers (PCL/PGA); lactide (PLA); and combinations thereof. By way ofexample only, the blend may include polyethylene glycol 3350 (PEG 3350),polyethylene glycol 400 (PEG 400), and/or other polyethylene glycols.

In yet further examples, the humidity tolerant adhesive materialscomprise a block copolymer of polyethylene glycol 20,000 (PEG 20,000)and poly(caprolactone)-glycolide copolymers (PCL/PGA) that arecharacterized by a molar ratio of 65:35 poly(caprolactone) (PCL) toglycolide (PGA). The resulting blends may have a relatively highmolecular weight and lower solubility.

As yet another merely illustrative example, the humidity tolerantadhesive materials comprise a blend of other water soluble copolymerswith poloxamers or PEG, with a molecular weight low enough to be clearedfrom the patient's body. Such a blend may be substituted for a componentof any of the blends described above; or for the entirety of any of theblends described above. By way of further example only, the polymer(s)in such a blend may be biodegradable such as PCL/PGA, etc.

3. Exemplary Humidity Tolerant Adhesive Materials Comprising SolidTriglycerides in Oil

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) comprise“plastic fats” comprising solid triglycerides in oil. In someillustrative examples, such humidity tolerant adhesive materials furthercomprise sorbents. Useful sorbents may be selected from the groupconsisting of: polysaccharides such as cellulose; cellulose derivatives,e.g., sodium carboxymethylcellulose (Na-CMC); starch; starch derivates;natural gums, e.g., agar and alginates; chitosan; pectin; gelatin; andcombinations thereof. Useful triglycerides may be selected from thegroup consisting of: decanoyl glycerides; octanoyl glycerides; andcombinations thereof—for example, Miglyol® 810, 812, 818 and 829 fromCaesar & Loretz GMBH (Hilden, Del.). Useful oils may be selected fromthe group consisting of: bis-diglyceryl polyacyladipate-1; glyceroltrioheptanoate; and combinations thereof—for example, Softisan® 645 andSpezialöl 107 from Cremer Care (Hamburg, GE). The resulting humiditytolerant adhesive materials may desirably provide for good adhesion toend effector (40) and good spreading properties.

4. Exemplary humidity Tolerant Adhesive Materials ComprisingHydrocolloid Gels

In some examples, the humidity tolerant adhesive materials (e.g., one ormore of layers (104, 114)) for a buttress body (102, 112) comprisehydrocolloid gels. In some illustrative examples, useful hydrocolloidgels may be selected from the group consisting of gels comprising:chitosan; carboxymethyl cellulose (CMC); ethyl cellulose;hydroxypropylmethyl cellulose; gelatin; and combinations thereof. Theresulting humidity tolerant adhesive materials may have a relativelyhigh water binding capacity.

B. Exemplary Patterning of Humidity Tolerant Adhesive Materials onButtress Body

Patterning of humidity tolerant adhesive material on a buttress body(102, 112) may be utilized to impact the strength of the adhesive bondof the buttress body (102, 112) to an end effector (40), particularly awet end effector (40). In exemplary embodiments in which it is desiredto reduce the overall adhesion of a buttress body (102, 112) to an endeffector (40) so that it may be more easily deployed or released fromend effector (40) (as in FIG. 5C for example), the humidity tolerantadhesive material may be applied to a buttress body (102, 112) in apattern selected from the group consisting of: stripes; discrete dots;lattices; and combinations thereof. Conversely, in exemplary embodimentsin which it is desired to increase the overall adhesion of a buttressbody (102, 112) to an end effector (40) so that it less readily deployedor released from end effector (40) (as in FIG. 5C for example), thehumidity tolerant adhesive materials may be applied in an adhesive layer(104, 114), that extends continuously along the entire surface ofbuttress body (102, 112).

FIG. 7 shows an exemplary buttress body (702) in which humidity tolerantadhesive material is applied to the buttress body (702) in a pattern ofobliquely oriented stripes (704). Generally it is theorized, but in noway limits the scope of this invention, that oblique stripes (704)present a continuous line to resist side loads that may be encounteredduring surgery by a buttress body (704) that has been adhered to an endeffector (40). In addition, it is believed that oblique stripes (704)minimize the percentage of area that is coated by the adhesive materialalong the axis of the buttress body (702) in the direction of the forcesthat will release the buttress body (702), so as allow the buttress body(702) to be readily deployed from the end effector (40) during asurgical procedure (as in FIG. 5C for example). In the present example,oblique stripes (704) are oblique in the sense that stripes (704) extendalong paths that are obliquely oriented relative to axes that areparallel to the longitudinal axis of buttress body (702). In someexemplary variations, stripes (704) extend along axial paths that areparallel to the longitudinal axis of buttress body (702).

FIG. 8 depicts a perspective view of an exemplary buttress body (802) inwhich humidity tolerant adhesive material has been applied in a patternof discrete, semi-rigid dots (804). The discrete, rigid semi-dots (804)may be sized and positioned to correspond with the positioning of stapleforming pockets (64) of anvil (60). Thus, the discrete, semi-rigid dotsof adhesive material (804) are may be arranged in four longitudinallyextending linear arrays, with each longitudinally extending linear arraycorresponding the longitudinally arrayed arrangement of staple formingpockets (64) of anvil (60). Alternatively, any other suitablearrangement may be used. Generally it is theorized, but in no way limitsthe scope of this invention, that adding the rigid dots (804) boosts themodulus of the humidity tolerant adhesive material, while having littleimpact on its cohesive strength.

FIG. 9 shows how buttress body (902) provides a lattice defining aplurality of cells (908). Due to the presence of cells (908) and theporous nature of buttress body (902), when the humidity tolerantadhesive material (904) is applied to the buttress body (902), it formsa lattice pattern by entering into some of those cells (908), therebypartially infusing buttress body (902) with the adhesive material. Inother words, buttress body (902) acts like a sponge absorbing theadhesive material, allowing the adhesive material to deform, surround,and essentially grab hold of the lattice connections within buttressbody (902).

In some instances, the humidity tolerant adhesive material is initiallyapplied to buttress body (902) when the adhesive material is in arelatively highly viscous form. Buttress body (902) is then heated todecrease the viscosity of the adhesive material, causing the adhesivematerial to enter some of the cells (908) of buttress body (902).Buttress body (902) is then cooled or allowed to cool, causing theviscosity of the adhesive material to increase back to its previousstate. Buttress body (902) may then be heated again as buttress body(902) is being applied to end effector (40) as described above. In someother versions, the adhesive material already has a low enough viscosityto enter cells (908) when the adhesive material is applied, withoutrequiring the adhesive material to be heated. In other words, theadhesive material may wick into cells (908) of buttress body (902). Insome such versions, a protective film (e.g., polytetrafluoroethylene(PTFE)) may be applied over the adhesive material to protect and/orcontain the adhesive material before buttress body (902) is applied toend effector (40). Other suitable ways in which buttress assembly (902)may be formed and provided are disclosed in U.S. patent application Ser.No. 14/667,842, entitled “Method of Applying a Buttress to a SurgicalStapler,” filed Mar. 25, 2015, issued as U.S. Pat. No. 10,349,939, onJul. 16, 2019, the disclosure of which is incorporated by referenceherein.

C. Reduction of Spontaneous Separation of Buttress from HumidityTolerant Adhesive Material

In some surgical applications, it may be desirable to reduce thespontaneous separation of a buttress body (102, 112) from the humiditytolerant adhesive material that has been applied thereto. Suchspontaneous separation or “de-wetting” may occur as a result of moisturebeing present on the end effector (40) to which the buttress body (102,112) has been adhered. In some instances, de-wetting may be minimized byone or more steps selected from the group consisting of: drying;priming; absorbing water; and combinations thereof. Each of these stepsis explained in further detail below.

In some instances, de-wetting may be minimized by drying the endeffector (40) prior to adhering a buttress body (102, 112) thereto. Inexemplary embodiments, drying the end effector (40) may be accomplishedby applying an absorbent to the end effector (40). For instance, endeffector (40) may be temporary clamped onto an absorbent platform (e.g.,comprising a polyacrylate pad) in order to substantially dry underside(65) of anvil (60) and deck (73) of staple cartridge (70) as describedin U.S. Patent App. No. 62/209,041, entitled “Method and Apparatus forApplying a Buttress to an End Effector of a Surgical Stapler,” filedAug. 24, 2015, the disclosure of which is incorporated by referenceherein. Other suitable ways in which end effector (40) may be driedprior to adhering a buttress body (102, 112) thereto will be apparent tothose of ordinary skill in the art in view of the teachings herein.

In some instances, de-wetting may be additionally or alternativelyminimized by priming the end effector (40) with a hydrophobic layerprior to adhering a buttress body (102, 112) thereto. In exemplaryembodiments, a sponge with an adhesive -miscible hydrophobe may beclamped onto the end effector (40) to make it temporarily hydrophobicprior to adhering a buttress body (102, 112) thereto. In exemplaryembodiments, adhesive -miscible hydrophobes may be selected from thegroup consisting of: ethyl citrate; triacetin; triolein; andcombinations thereof.

In some versions, the adhesive -miscible hydrophobes may be applied asfollows.

One or more adhesive -miscible hydrophobes may be pre-loaded into anopen cell foam layer. The open cell foam layer may be loaded andsqueezed between the buttress bodies (102, 112) after the buttressbodies (102, 112) have been adhered onto the anvil (60) and lower jaw(50) of the end effector (40). During squeezing of the open cell foamlayer, at least a portion of the adhesive -miscible hydrophobe(s) maymigrate from the open cell foam layer, through the buttress bodies (102,112) to the interface between the humidity tolerant adhesive materialand the anvil (60) or staple cartridge (70) of the end effector (40),creating a temporarily hydrophobic environment that may be favorable tomaintaining good adhesive properties.

In some instances, de-wetting may be additionally or alternativelyminimized by coating all or a portion of the end effector (40), e.g. theanvil (60) and/or staple cartridge (70), with a hydrophobic lubriciouscoating comprising calcium stearate or magnesium stearate.

In some instances, de-wetting may be additionally or alternativelyminimized by absorbing moisture away from the surface of the endeffector (40). In some such versions, this may be accomplished by mixinga hydrocolloid into the humidity tolerant adhesive material at the timethat the adhesive is made. Generally it is theorized, but in no waylimits the scope of this invention, that hydrocolloids provide theresulting humidity tolerant adhesive material with wet tackcharacteristics that enable the adhesive material to stick to both wetand dry surfaces. Suitable compositions that may form the hydrocolloidmay be selected from the group consisting of: carboxy methylcellulose(CMC); gelatin; hyaluronate; and combinations thereof.

In some instances, moisture may additionally or alternatively beabsorbed away from the surface of the end effector (40) by adding ahydrophilic block to one of the polymers or co-polymers that form thehumidity tolerant adhesive material. Suitable hydrophilic blocks may beselected from the group consisting of: polyethylene glycol (PEG);polyvinyl pyrrolidine (PVP); and combinations thereof.

D. Reduction of Forces on Buttress Bodies Against Tissue

As noted above in reference to FIG. 6 , a series of staples (90) maycapture and retain buttress assemblies (100, 110) against layers oftissue (T₁, T₂), thereby securing buttress assemblies (100, 110) totissue (T₁, T₂). In some surgical procedures, it may be desirable toreduce forces that are exerted against the buttress assemblies (100,110) when they are being placed, or are in place, against the layers oftissue (T₁, T₂). Such a reduction in force may allow for better adhesionof the buttress bodies (102, 112) to the end effector (40). In addition,or in the alternative, it may be desirable to reduce forces that maydamage the layers of tissue (T₁, T₂) that are to be, or have been,secured. In illustrative examples, this may be accomplished by treatingthe tissue-contacting surfaces of one or more buttress assemblies (100,110) so that they become lubricious. Generally it is theorized, but inno way limits the scope of this invention, that a lubricious buttressbody (102, 112) surface may reduce the shear force, i.e., drag force,that is applied between the layers of tissue (T₁, T₂) and buttressassemblies (100, 110). Exemplary substances that may be applied to thetissue-contacting surfaces of one or more buttress assemblies (100, 110)to make them lubricious may be selected from the group consisting of:polyethylene glycol 200 (PEG 200); silicone; oil; and combinationsthereof.

In further illustrative examples, forces may additionally oralternatively be reduced by modifying the edges of the buttress bodyassembly (100, 110). Generally it is theorized, but in no way limits thescope of this invention, that such modifications of the edges of thebuttress body assembly (100, 110) may minimize snagging and/or grippingon the layers of tissue (T₁, T₂) by the buttress assemblies (100, 110)when they are being placed, or are in place, against the layers oftissue (T₁, T₂), and vice versa. Useful means of modifying the edges ofthe buttress body assembly (100, 110) may be selected from the groupconsisting of: radiusing; chamfering; and combinations thereof.

In addition to the foregoing, it should also be understood that any ofthe various buttress assemblies described herein may be furtherconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, issued as U.S. Pat. No. 10,349,939 on Jul. 16, 2019, thedisclosure of which is incorporated by reference herein.

IV. EXEMPLARY COMBINATIONS

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

A method of applying a buttress to a wet surgical stapler end effectorwith a humidity tolerant adhesive, the method comprising the steps of:(a) positioning a buttress assembly between an anvil and a staplecartridge of the end effector, wherein the buttress assembly comprises:(i) a buttress body, and (ii) a humidity tolerant adhesive material,wherein the humidity tolerant adhesive material faces either anunderside of the anvil or a deck of the staple cartridge, wherein theanvil is in an open position relative to the staple cartridge during theact of positioning the buttress assembly between the anvil and thestaple cartridge; (b) moving the anvil toward the staple cartridge; and(c) moving the anvil back to the open position, wherein the buttressassembly is adhered to the underside of the anvil or the deck of thestaple cartridge via the humidity tolerant adhesive material with theanvil moved back to the open position, wherein the humidity tolerantadhesive material holds the buttress body to the underside of the anvilor the deck of the staple cartridge for at least five minutes in anenvironment of 100% relative humidity.

Example 2

The method of Example 1, wherein the humidity tolerant adhesive materialholds the buttress body to the underside of the anvil or the deck of thestaple cartridge for at least ten minutes in an environment of 100%relative humidity at body temperature after the humidity tolerantadhesive material has been exposed to a relative humidity of from about20% to about 40% for up to one hour at room temperature.

Example 3

The method of any one or more of Examples 1 through 2, wherein thehumidity tolerant adhesive material comprises a blend of poloxamers.

Example 4

The method of Example 3, wherein the poloxamers are selected from thegroup consisting of: poloxamer 188; Synperonic® PE/P84; poloxamer 124;poloxamer 407; and combinations thereof.

Example 5

The method of any one or more of Examples 1 through 4, wherein thehumidity tolerant adhesive material comprises a mixture of polyethyleneglycol having a molecular weights of from about 200 to about 20,000.

Example 6

The method of any one or more of Examples 1 through 5, wherein thehumidity tolerant adhesive material comprises copolymers selected fromthe group consisting of: polyethylene-polyethylene glycol copolymers;poly(caprolactone)-glycolide copolymers; and combinations thereof.

Example 7

The method of Example 6, wherein the humidity tolerant adhesive materialcomprises a blend of polyethylene-polyethylene glycol copolymers andpoly(caprolactone)-glycolide copolymers in the ratio of from about 40:60to about 60:40 of polyethylene-polyethylene glycol copolymers topoly(caprolactone)-glycolide copolymers.

Example 8

The method of any one or more of Examples 1 through 7, wherein thehumidity tolerant adhesive material comprises a block copolymer ofpolyethylene glycol and poly(caprolactone)-glycolide copolymer.

Example 9

The method of any one or more of Examples 1 through 8, wherein thehumidity tolerant adhesive material comprises triglycerides.

Example 10

The method of any one or more of Examples 1 through 9, wherein thehumidity tolerant adhesive material comprises a hydrocolloid gel.

Example 11

A buttress assembly that is configured to temporarily adhere to a wetsurgical stapler end effector, the buttress assembly comprising: (a) abuttress body; and (b) humidity tolerant adhesive material, wherein thehumidity tolerant adhesive material is applied to at least one side ofthe buttress body, wherein the humidity tolerant adhesive material isconfigured to hold the buttress body to an underside of an anvil or adeck of a staple cartridge for at least five minutes in an environmentof 100% relative humidity at approximately 37° C.

Example 12

The buttress assembly of Example 11, wherein the humidity tolerantadhesive material is configured to hold the buttress body to theunderside of the anvil or the deck of the staple cartridge for at leastfive minutes in an environment of 100% relative humidity atapproximately 37° C. after the humidity tolerant adhesive material hasbeen exposed to a relative humidity of from about 20% to about 60% forup to one hour at a temperature between approximately 20° C. andapproximately 22° C.

Example 13

The buttress assembly of any one or more of Examples 11 through 12,wherein the humidity tolerant adhesive material comprises a blend ofpoloxamers.

Example 14

The buttress assembly of any one or more of Examples 11 through 13,wherein the humidity tolerant adhesive material comprises a mixture ofpolyethylene glycol having a molecular weights of from about 200 toabout 20,000.

Example 15

The buttress assembly of any one or more of Examples 11 through 14,wherein the humidity tolerant adhesive material comprises copolymersselected from the group consisting of: polyethylene-polyethylene glycolcopolymers; poly(caprolactone)-glycolide copolymers; and combinationsthereof.

Example 16

The method of any one or more of Examples 11 through 15, wherein thehumidity tolerant adhesive material comprises a blend ofpolyethylene-polyethylene glycol copolymers andpoly(caprolactone)-glycolide copolymers in the ratio of from about 40:60to about 60:40 of polyethylene-polyethylene glycol copolymers topoly(caprolactone)-glycolide copolymers.

Example 17

The buttress assembly of any one or more of Examples 11 through 16, thehumidity tolerant adhesive material comprises a block copolymer ofpolyethylene glycol and poly(caprolactone)-glycolide copolymer.

Example 18

The buttress assembly of any one or more of Examples 11 through 17,wherein the humidity tolerant adhesive material comprises triglycerides.

Example 19

The buttress assembly of any one or more of Examples 11 through 18,wherein the wherein the humidity tolerant adhesive material comprises ahydrocolloid gel.

Example 20

A buttress assembly that is configured to temporarily adhere to a wetsurgical stapler end effector, the buttress assembly comprising: (a) abuttress body; and (b) humidity tolerant adhesive material, wherein thehumidity tolerant adhesive material is applied to at least one side ofthe buttress body, wherein the humidity tolerant adhesive material isconfigured to hold the buttress body to an underside of an anvil or adeck of a staple cartridge for at least five minutes in an environmentof 100% relative humidity at approximately 37° C., wherein the humiditytolerant adhesive material comprises a combination of solidtriglycerides in oil and one or more sorbents.

V. MISCELLANEOUS

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

In addition to the foregoing, it should also be understood that any ofthe various buttress assemblies described herein may be furtherconstructed and operable in accordance with at least some of theteachings of U.S. patent application Ser. No. 14/667,842, entitled“Method of Applying a Buttress to a Surgical Stapler,” filed Mar. 25,2015, issued as U.S. Pat. No. 10,349,939 on Jul. 16, 2019, thedisclosure of which is incorporated by reference herein; U.S. patentapplication Ser. No. 14/827,856, entitled “Implantable Layers for aSurgical Instrument,” filed Aug. 17, 2015, issued as U.S. Pat. No.10,835,249 on Nov. 17, 2020, the disclosure of which is incorporated byreference herein; U.S. patent application Ser. No. 14/871,071, entitled“Compressible Adjunct with Crossing Spacer Fibers,” filed Sep. 30, 2015,issued as U.S. Pat. No. 10,433,846 on Oct. 8, 2019, the disclosure ofwhich is incorporated by reference herein; and U.S. patent applicationSer. No. 14/871,131, entitled “Method for Applying an Implantable Layerto a Fastener Cartridge,” filed Sep. 30, 2015, published on U.S. Pub.No. 2017/0086842, on Mar. 30, 2017, the disclosure of which isincorporated by reference herein. Furthermore, in addition to themethods described herein, any of the various buttress assembliesdescribed herein may be applied to end effector (40) in accordance withat least some of the teachings of U.S. Provisional Patent App. No.62/209,041, entitled “Method and Apparatus for Applying a Buttress toEnd Effector of a Surgical Stapler,” filed Aug. 24, 2015, the disclosureof which is incorporated by reference herein; and/or U.S. patentapplication Ser. No. 14/871,131, entitled “Method for Applying anImplantable Layer to a Fastener Cartridge,” filed Sep. 30, 2015,published as U.S. Pub. No. 2017/0086842 on Mar. 30, 2017, the disclosureof which is incorporated by reference herein. Various suitable ways inwhich the teachings herein may be combined with various teachings of theabove-cited references will be apparent to those of ordinary skill inthe art.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof any of the following: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity,” issued Aug. 11, 1998, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.5,817,084, entitled “Remote Center Positioning Device with FlexibleDrive,” issued Oct. 6, 1998, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,878,193, entitled “Automated EndoscopeSystem for Optimal Positioning,” issued Mar. 2, 1999, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,231,565,entitled “Robotic Arm DLUS for Performing Surgical Tasks,” issued May15, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.6,364,888, entitled “Alignment of Master and Slave in a MinimallyInvasive Surgical Apparatus,” issued Apr. 2, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System for Robotic SurgicalTools,” issued Apr. 28, 2009, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism,” issued Apr. 6, 2010, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,806,891, entitled “Repositioningand Reorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery,” issued Oct. 5, 2010, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2013/0012957, entitled“Automated End Effector Component Reloading System for Use with aRobotic System, published Jan. 10, 2013, issued as U.S. Pat. No.8,844,789, on Sep. 2, 2014, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199630, entitled“Robotically-Controlled Surgical Instrument with Force-FeedbackCapabilities,” published Aug. 9, 2012, issued as U.S. Pat. No.8,820,605, on Sep. 2, 2014, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0132450, entitled “Shiftable DriveInterface for Robotically-Controlled Surgical Tool,” published May 31,2012, issued as U.S. Pat. No. 8,616,431, on Dec. 31, 2013, thedisclosure of which is incorporated by reference herein; U.S. Pub. No.2012/0199633, entitled “Surgical Stapling Instruments with Cam-DrivenStaple Deployment Arrangements,” published Aug. 9, 2012, issued as U.S.Pat. No. 8,573,461 on Nov. 5, 2013, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2012/0199631, entitled“Robotically-Controlled Motorized Surgical End Effector System withRotary Actuated Closure Systems Having Variable Actuation Speeds,”published Aug. 9, 2012, issued as U.S. Pat. No. 8,602,288 on Dec. 10,2013, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2012/0199632, entitled “Robotically-Controlled SurgicalInstrument with Selectively Articulatable End Effector,” published Aug.9, 2012, issued as U.S. Pat. No. 9,301,759 on Apr. 5, 2016,thedisclosure of which is incorporated by reference herein; U.S. Pub. No.2012/0203247, entitled “Robotically-Controlled Surgical End EffectorSystem,” published Aug. 9, 2012, issued as U.S. Pat. No. 8,783,541 Jul.22, 2014, the disclosure of which is incorporated by reference herein;U.S. Pub. No. 2012/0211546, entitled “Drive Interface for OperablyCoupling a Manipulatable Surgical Tool to a Robot,” published Aug. 23,2012, issued as U.S. Pat. No. 8,479,969 on Jul. 9, 2013; U.S. Pub. No.2012/0138660, entitled “Robotically-Controlled Cable-Based Surgical EndEffectors,” published Jun. 7, 2012, issued as U.S. Pat. No. 8,800,838Aug. 12, 2014, the disclosure of which is incorporated by referenceherein; and/or U.S. Pub. No. 2012/0205421, entitled“Robotically-Controlled Surgical End Effector System with RotaryActuated Closure Systems,” published Aug. 16, 2012, issued as U.S. Pat.No. 8,573,465 on Nov. 5 2013, the disclosure of which is incorporated byreference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a user immediately prior to a procedure. Those skilled in the artwill appreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a suitable closed and sealed container. Thecontainer and device may then be placed in a field of radiation that canpenetrate the container, such as gamma radiation, x-rays, or high-energyelectrons. The radiation may kill bacteria on the device and in thecontainer. The sterilized device may then be stored in the sterilecontainer for later use. A device may also be sterilized using any othertechnique known in the art, including but not limited to beta or gammaradiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

We claim:
 1. A buttress assembly that is configured to temporarilyadhere to a wet surgical stapler end effector, the buttress assemblycomprising: (a) a buttress body comprising a collagen matrix; and (b) ahumidity tolerant adhesive material that comprises a de-wetting agentconfigured to absorb moisture, wherein the humidity tolerant adhesivematerial is disposed on at least one side of the buttress body.
 2. Thebuttress assembly of claim 1, wherein the humidity tolerant adhesivematerial comprises polymers that are: (a) bioabsorbable polymers, and/or(b) polymers having a molecular weight of less than about 30,000 kDa. 3.The buttress assembly of claim 1, wherein the humidity tolerant adhesivematerial comprises sorbents selected from the group of: cellulose,cellulose derivatives, starch, starch derivates, natural gums, chitosan,pectin, gelatin and combinations thereof.
 4. The buttress assembly ofclaim 3, wherein the sorbents comprise cellulose derivatives, andwherein the cellulose derivatives comprise carboxymethyl cellulose. 5.The buttress assembly of claim 3, further comprising a hydrophobic layerdisposed between the buttress body and the humidity tolerant adhesivematerial, wherein the hydrophobic layer comprises adhesive-misciblehydrophobes selected from the group of: ethyl citrate, triacetin,triolein and combinations thereof.
 6. The buttress assembly of claim 1,wherein the de-wetting agent comprises a hydrocolloid gel, thehydrocolloid gel in turn comprising a blend of: (a) one or morepolymers, and (b) one or more sorbents; wherein the one or more polymersand one or more sorbents are present in the humidity tolerant adhesivematerial at a ratio of 20:30 of sorbent to polymer.
 7. The buttressassembly of claim 1, wherein the humidity tolerant adhesive materialcomprises a blend of polyethylene-polyethylene glycol copolymers andpoly(caprolactone)-glycolide copolymers.
 8. The buttress assembly ofclaim 1, wherein the humidity tolerant adhesive material comprises ablock copolymer of polyethylene glycol and poly(caprolactone)-glycolidecopolymer.
 9. The buttress assembly of claim 1, wherein the humiditytolerant adhesive material is configured to hold the buttress body to anunderside of an anvil or a deck of a staple cartridge for at least fiveminutes in an environment of 100% relative humidity at about 37° C.after the humidity tolerant adhesive material has been exposed to arelative humidity of from about 20% to about 60% for up to one hour atbetween about 20° C. and about 22° C.
 10. A buttress assembly that isconfigured to temporarily adhere to a wet surgical stapler end effector,the buttress assembly comprising: (a) a buttress body comprising acollagen matrix; and (b) a humidity tolerant adhesive material disposedon at least one side of the buttress body, wherein the humidity tolerantadhesive material comprises a de-wetting agent configured to absorbmoisture, wherein the humidity tolerant adhesive material is configuredto secure the buttress body to a stapling surface of the wet surgicalstapler end effector for at least five minutes in an environment of 100%relative humidity at about 37° C. after the humidity tolerant adhesivematerial has been exposed to a relative humidity of from about 20% toabout 60% for up to one hour at between about 20° C. and about 22° C.11. The buttress assembly of claim 10, wherein the humidity tolerantadhesive material comprises: (a) bioab sorb able polymers, and/or (b)polymers having a molecular weight of less than about 30,000 kDa. 12.The buttress assembly of claim 10, wherein the humidity tolerantadhesive material comprises sorbents selected from the group of:cellulose, cellulose derivatives, starch, starch derivates, naturalgums, chitosan, pectin, gelatin and combinations thereof.
 13. Thebuttress assembly of claim 12, wherein the sorbents comprise cellulosederivatives, wherein the cellulose derivatives comprise carboxymethylcellulose.
 14. The buttress assembly of claim 10, wherein the de-wettingagent comprises a hydrocolloid gel, the hydrocolloid gel in turncomprising a blend of: (a) one or more polymers, and (b) one or moresorbents; wherein the one or more polymers and the one or more sorbentsare present in the humidity tolerant adhesive material at a ratio of20:30 of sorbent to polymer.
 15. The buttress assembly of claim 10,wherein the humidity tolerant adhesive material comprises a blend ofpolyethylene-polyethylene glycol copolymers andpoly(caprolactone)-glycolide copolymers.
 16. The buttress assembly ofclaim 10, wherein the humidity tolerant adhesive material comprises ablock copolymer of polyethylene glycol and poly(caprolactone)-glycolidecopolymer.
 17. The buttress assembly of claim 10, further comprising ahydrophobic layer disposed between the buttress body and the humiditytolerant adhesive material.
 18. The buttress assembly of claim 17,wherein the hydrophobic layer comprises adhesive-miscible hydrophobesselected from the group of: ethyl citrate, triacetin, triolein andcombinations thereof.
 19. A buttress assembly that is configured totemporarily adhere to a wet surgical stapler end effector, the buttressassembly comprising: (a) a buttress body comprising a collagen matrix;(b) a humidity tolerant adhesive material; and (c) a hydrophobic layerdisposed between the buttress body and the humidity tolerant adhesivematerial, wherein the humidity tolerant adhesive material comprises:polymers selected from the group of: (A) bioabsorbable polymers, or (B)polymers having a molecular weight of less than about 30,000 kDa; and(ii) sorbents selected from the group of: cellulose, cellulosederivatives, starch, starch derivates, natural gums, chitosan, pectin,gelatin and combinations thereof.
 20. The buttress assembly of claim 19,wherein the humidity tolerant adhesive material comprises a de-wettingagent configured to absorb moisture.